AP Psych: Clinical Psychology

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Historically: 3 Basic Causes of Disorders

• supernatural (gods and devil/possession)

• organic/biological

• psychological

DSM (Diagnostic and Statistical Manual of Mental Disorders)

• Used to DIAGNOSE disorders

• Contains detailed lists of observable behaviors that must be present in order for a diagnosis to be made

The Rosenhan Study

• Study that changed how we diagnose mental disorders (DSM changed from descriptive to checklists)

• 8 "pseudopatients" purposefully gotthemselves admitted to a psychiatric hospitalto see how patients were treated

Using the DSM-V advantages

• Provides a common basis for communication

• Inter-rater reliability - 83%

• Helps clinicians make predictions

• Allows insurance coverage

Using the DSM-V disadvantages

• Classification based on the medical (checklists) model

• Manual may include too many behaviors

• 26% can be diagnosed in any given year, 46% at some point in their life time

• DOES NOT OFFER TREATMENT SUGGESTIONS

Depressive Disorders (most common feature)

Significant feelings of sadness, emptiness, or irritability that are accompanied by somatic and cognitive disruptions that significantly affect daily function

Disruptive Mood Dysregulation Disorder

• Characteristics: Frequent temper tantrums that are not appropriate for their developmental stage

• Only diagnosable between the ages of 6 and 17

• More often seen in boys than girls

Comorbidity

presence of 2 or more disorders in one person

Major Depressive Disorder (MDD)

• Episodes of deep unhappiness

• Loss of interest in life

MDD Prevalence Rates

Globally around 5% of people have MDD, found more in women than men

Persistent Depressive (Dysthymic) Disorder

chronic depression (Unbroken depressed mood lasting most of 2 years)

Etiology (cause) of MDD and Persistent Depressive Disorder

low levels of serotonin lead to low levels of norepinephrine, genetic link, learned helplessness, Maladaptive thought patterns

Seasonal Affective Disorder

Same as for depression, but must occur at the same time of year each year (typically winter time), treatment is light therapy

Bipolar Disorder

Must show a pattern of fluctuation between mania and major depression

mania

extremely elated mood and activity, to the point of danger

biological cause for bipolar disorder

• Alteration of Neurotransmitters

• Too little Serotonin (Depression)

• Too much Norepinephrine (mania)

genetic cause for bipolar disorder

bipolar disorder is super inheritable

psychological cause for bipolar disorder

Diathesis-Stress Model: An individual has agenetic predisposition, and the disease is "turned-on" when certain environmental stimuli (stress) trigger it

anxiety disorders

• Most common mental disorders in the U.S.

• All are more common in women

Generalized Anxiety Disorder (GAD)

Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events

risk factors for generalized anxiety disorder

• Personality (highly neurotic)

• Overly critical parents

• Negative coping styles

Panic Disorder

Recurrent, sudden onsets of intense terror (panic attacks) that often occur without warning• Can occur with or without agoraphobia (anxiety about being in places you cannot escape)

Fear of fear

after having one panic attack, you become so afraid of another one that it causes you to fall into a cycle of attacks and worry (i.e. reinforced)

Social Anxiety Disorder (social phobia)

• Overwhelming anxiety and fear when in social situations

• Includes intense fear of being criticized or judged

Phobic Disorder

an irrational, overwhelming, persistent fear of a particular object or situation

psychodynamic approach to anxiety disorders

we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety

behaviorist approach to anxiety disorders

fear conditioning leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced

learning approach to anxiety disorders

fear responses are acquired through observational learning.

Evolutionary and Biological approach to anxiety disorders

Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety

Biological approach to anxiety disorders

• Lower levels of GABA (major inhibitory NT) in the brain
• Overactive autonomic nervous system

OCD (Obsessive Compulsive Disorder)

Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.

OCD prevalence

1 - 2% of population, equal ratio of men:women

OCD Causes: Biological

genetics, overactive frontal cortex

OCD causes (psychological)

stress

hoarding

A subtype of OCD where you are compelled to accumulate and keep things

body dysmorphic disorder

Disorder where you are obsessed with perceived flaw in appearance, and feel compelled to do something about it

acute stress disorder/ptsd

A variety of symptoms may develop as a result of exposure to a traumatic event, oppressive situation, natural or unnatural disaster (flashbacks, memory issues)

acute stress disorder vs PTSD

Acute stress disorder can be diagnosed 2 to 3 days after the event is over, and is a disorder of short-term reactions to trauma. PTSD can be diagnosed beginning one month after the event, and represents chronic, long-term maladaptive coping.

Schizophrenia

•Characterized by highly disordered thought processes
•Usually diagnosed between 18 - 25 years of age
•Effects 1% of the population
•NOT Dissociative Identity Disorder (multiple personalities)

Schizophrenia (positive symptoms)

hallucinations and delusions, catatonic behavior

Schizophrenia (negative symptoms)

attention difficulties, memory problems, flat effect

flat effect

lack of emotional response; no expression of feeling; voice monotonous and face immobile

Catatonic Behavior

individual freezes in any given state for hours to days, exhibit waxy flexibility

delusions

fixed false beliefs

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

schizophrenia genetic factors

Results in alteration in dopamine (too much), Enlarged ventricles (which means less mass)

schizophrenia psychological factors

diathesis stress

biological treatments for schizophrenia

Prefrontal lobotomy - The frontal lobes of the brain are severed from the deeper centers of the brain. (irreversible, no longer used)

early treatments for schizophrenia

•Electroconvulsive Therapy (ECT) (also called shock therapy)
•ECT is used for severely depressed patients who do not respond to drugs.

medication for depression/bipolar disorder

•SSRIs (Zoloft, Paxil, Prozac)

• Selective Serotonin Reuptake Inhibitor •SNRIs (Effexor, Cymbalta)

• Selective Norephinephrine reuptake inhibitor

medication for bipolar disorder

Mood stabilizers (lithium)

medications For Anxiety and Related Disorders

•Anti-anxiety medications (anxiolytics)
•Benzodiazapines (valium, xanax)
•Barbiturates
•Side effects:
•Over-dose
•Heavy sedation
•Dependence!

medications for schizophrenia

Antipsychotics (clozapine and thorazine)

side effects of schizophrenia medication

tardive dyskinesia, extreme drowsiness, seizures, weight gain, loss of white blood cells, damage to immune system, slowed mental functioning, depression

tardive dyskinesia

parkinsonian-like tremors due to too little dopamine

Cognitive therapy

focused on teaching adaptive change in thinking

Cognitive Restructuring

learn how to identify disordered thinking (Cognitions) and change them

Emphasis of Cognitive therapy

Thoughts are the primary source of abnormal behavior and psychological problems

Beck's Cognitive Therapy

• Illogical thoughts -> psychologicalproblems

• Challenge accuracy of automaticthoughts

• Less directive; has a reflective, open-ended dialogue

Ellis's Rational-Emotive Behavior Therapy

• irrational and self-defeating beliefs are harmful

• Eliminate beliefs through rational examination

Cognitive Behavioral Therapy (CBT)

• Pushes for self-efficacy

• Confronts the illogical/irrational thoughts and changes them and the behaviors associated with it

mary cover jones

mother of behavior therapy

counterconditioning

using classical conditioning to remove a classically conditioned response

MCJ created desensitization therapy

1. find a positive stimulus to pair with the negative stimulus 2. slowly introduce the pairing over time

joseph wolpe - systemic desensitization

First train an individual with phobias in relaxation techniques, and then slowly expose them to more anxiety-provoking stimuli while relaxed

biofeedback

electronic measuring of biological functions (heart rate, blood pressure, brainwaves, etc) is shown to a patient, who is then taught to control it

exposure therapy

Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.

Dissociative Disorders

Characterized by disruptions in memory and identity in response to trauma

Dissociative Amnesia

• Inability to remember parts of the past as a result of psychological trauma

• Not due to biological (physical) trauma (i.e. brain damage)

Dissociative Amnesia plus Fugue

A. Sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past
B. Confusion about personal identity or assumption of a new identity (partial or complete)

Dissociative Identity Disorder

The presence of two or more distinct identities or personality states plus impaired memory

Dissociative Identity Disorder risk factors

Severe child abuse, especially sexual abuse (reported in 95% of cases)

Dissociative Identity Disorder prevalence

• Up for debate

• Rates have increased dramatically over few decades

Explanations for increasing prevalence of DID

• Increased public awareness of the disorder

• Changes in the diagnostic criteria for schizophrenia

• Therapists may be actively looking for DID

reasons for debate about increasing prevalence of DID

• Rates very uneven across countries

• Rates very uneven across clinicians within countries

integration therapy (DID)

integration is fully embracing each and every part/aspect of myself. Full acceptance allows greater self-control and choices.

Somatic Disorders

Disorders caused by psychological stress that manifest as physical (somatic) problems

Somatic symptom (hypochondriasis)

extreme anxiety about physical symptoms that are interpreted as evidence of illness

Illness anxiety disorder

severe obsession with having or getting a serious illness with no physical symptoms

Conversion Disorder

Physical Loss of Function With No Physical Reason

Factitious disorder AND Factitious disorder imposed on another (Munchausen syndrome)

Falsely reporting, or deliberately creating or exaggerating symptoms to get medical attention

Causes of Somatoform Disorders

• psychoanalytic: Unconscious acting on problems from childhood

• behavioral: Negative reinforcement - feel better when anxiety is reduced, Positive reinforcement - attention makes you feel better

• cognitive: People victimize themselves through their own beliefs that they are worthless or inadequate.

treatments for somatoform disorders

• CBT

• anti anxiety drugs

• anti depressants

Personality Disorders

Pervasive pattern of distorted thinking, interpersonal difficulties, and problems with emotional responses

Paranoid Personality Disorder

Pattern of distrust and suspiciousness about other people's motives (cluster A: Odd, Suspicious, and Eccentric)

Cluster B personality disorders

antisocial, borderline, histrionic, narcissistic

Borderline Personality Disorder

Significant and disruptive pattern of instability in interpersonal relationships, mood, self-image, and impulse control

Histrionic Personality Disorder

excessive attention-seeking emotions, including inappropriately seductive behavior and an excessive need for approval

Narcissistic Personality Disorder

exaggerated sense of self-importance, excessive need for admiration, and a lack of empathy

antisocial personality disorder

THIS IS NOT being "antisocial" - its more like "antisociety" - disregard for social norms, lack of empathy, frequent violating of the law and manipulation of other people

Cluster C disorders

avoidant, dependent, obsessive-compulsive

avoidant personality disorder

severe social anxiety, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, despite a strong desire for intimacy

dependent personality disorder

helplessness, submissiveness, a need to be taken care of and for constant reassurance, and an inability to make decisions

obsessive-compulsive personality disorder

disruptive preoccupation with orderliness, perfectionism, and personal and interpersonal control (difference b/w this and OCD is the anxiety associated with the compulsions, and the nature of the compulsions)

Treatment of Personality Disorders

CBT, These are the most difficult of all disorders to treat, because they're so ingrained in your everyday life

Dorothea Dix

Advocated for humane and moral treatment in the U.S.

Treatment Today: Focus on Deinstutionalization

Release of patients back into their usual community using out- patient care (come in for daily therapy, go home at night - may or may not go to a job)

insanity defense

individual is not responsible for their actions due to an episodic or persistent mental psychiatric disease at the time of the criminal offense

flooding therapy

extreme exposure to "shock the system" out of the fear